-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, SgcpOnKL6bgS1VElkQ8091QqwuDS87xuds5U3C1rMgMILkDeTs4oK+owP0mD2bxC QuMaZ03+/1zEEJkDrk7OTQ== 0000931731-03-000002.txt : 20030106 0000931731-03-000002.hdr.sgml : 20030106 20030106080316 ACCESSION NUMBER: 0000931731-03-000002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021231 FILED AS OF DATE: 20030106 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: STANGER KENT W CENTRAL INDEX KEY: 0000901531 RELATIONSHIP: DIRECTOR IRS NUMBER: 870447695 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 79 WEST 4500 SOUTH STREET 2: SUITE 9 CITY: SALT LAKE CITY STATE: UT ZIP: 84107 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MERIT MEDICAL SYSTEMS INC CENTRAL INDEX KEY: 0000856982 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 870447695 STATE OF INCORPORATION: UT FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 03503936 BUSINESS ADDRESS: STREET 1: 1600 WEST MERIT PARK WAY CITY: SOUTH JORDAN STATE: UT ZIP: 84095 BUSINESS PHONE: 8012531600 MAIL ADDRESS: STREET 1: 1600 WEST MERIT PARKWAY CITY: SOUTH JORDAN STATE: UT ZIP: 84095 4 1 kentform4-5.txt KWS FORM 4 12312002 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 [ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* STANGER KENT W. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 1600 West Merit Parkway - -------------------------------------------------------------------------------- (Street) South Jordan UT 84095 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Merit Medical Systems, Inc. (MMSI) - -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Year December 31, 2002 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) Page 1 of 3 Pages - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) Chief Financial Officer - -------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [ ] Form filed by more than one Reporting Person - --------------------------------------------------------------------------------
Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 5. 6. 4. Amount of Owner- Securities Acquired (A) or Securities ship Disposed of (D) Beneficially Form: 7. 3. (Instr. 3, 4 and 5) Owned at End Direct Nature of 2. Transaction of Issuer's (D) or Indirect 1. Transaction Code (A) Fiscal Year Indirect Beneficial Title of Security Date (Instr. 8) Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) =========================================================================================================================== Common Stock No Par Value 12/31/02 G(3) V 70,000 D D - --------------------------------------------------------------------------------------------------------------------------- Common Stock No Par Value 12/31/02 G(3) V 70,000 A I(4) - --------------------------------------------------------------------------------------------------------------------------- Common Stock No Par Value 12/31/02 S 5,000 D $19.92 I - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- Common Stock No Par Value 315,908 D - --------------------------------------------------------------------------------------------------------------------------- Common Stock Family limited No Par Value 65,078 I partnership - --------------------------------------------------------------------------------------------------------------------------- Common Stock 401(k No Par Value N/A 26,078 I plan (1) - --------------------------------------------------------------------------------------------------------------------------- Common Stock Emp stock pur- No Par Value N/A 1,923 D chase Plan(2) - ---------------------------------------------------------------------------------------------------------------------------
Page 2 of 3 Pages FORM 4 (continued) ================================================================================ Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
9. 10. Number Owner- of ship 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- Securities Date Securities Price Bene- ity: In- cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- 4. or Disposed Expiration Date Deriv- Owned (D) or Bene- 1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date action (Instr. 3, or Secur- of direct Owner Derivative ative (Month /Code 4 and 5) Date Expira- Number ity Year (I) -ship Security Secur- Day/ (Instr. 8 Exer- tion of (Instr.(Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) =================================================================================================================================== Non-qualified $3.68 N/A 09/30/99 03/31/04 Common 15,625 D stock options (7) Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $3.76 N/A 05/26/99 05/26/04 Common 11,719 D stock options Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $4.1997 N/A 04/23/00 10/23/04 Common 13,673 D stock options (8) Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $2.88 N/A 05/24/00 05/24/05 Common 11,719 D stock options Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $2.88 N/A 01/24/01 05/24/05 Common 31,250 D stock options Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $3.68 N/A 02/12/02 02/12/11 Common 31,250 D stock options (9) Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $5.0624 N/A 05/23/01 05/23/11 Common 15,625 D stock options Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $13.528 N/A 12/08/02 12/08/11 Common 25,000 D stock options (5) Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $16.99 N/A 05/23/02 05/23/12 Common 10,000 D stock options Stock (Right to Buy) ===================================================================================================================================
Explanation of Responses: (1) Represents plan holdings as of 10/28/02 (2) Represents Plan (3) Gift to family limited partnership (4) This report shall not be deemed an admission that the reporting person is the beneficial owner of the securities held by the K.W.S. Properties LC (5) Becomes exercisable in equal installments of 20% commencing 12/08/02 (7) Becomes exercisable in equal installments of 20% commencing 09/30/99 (8) Becomes exercisable in equal installments of 20% commencing 04/23/00 (9) Becomes exercisable in equal installments of 20% commencing 04/12/02 /s/ KENT W. STANGER 01/03/03 - ----------------------------------- ----------- **Signature of Reporting Person Date ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). Note:File three copies of this form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. Page 3 of 3 Pages -----END PRIVACY-ENHANCED MESSAGE-----